Radiology and the Art of Lego

Dr. Vikas Shah (@DrVikasShah) is a UK-based radiologist who specializes in abdominal imaging. His 124 cases on Figure 1 focus on promoting radiology education to both experienced radiologists and non-radiologists. Outside of work, Dr. Shah enjoys travelling and spending time with his family, and is slowly but surely mastering the art of Lego.

Imaging and Clinical Practice

For your educational mission for non radiologists, how do you approach ordering strategies and appropriateness criteria? While I think many of our colleagues are quite passable in their interpretations I often get the most pushback when it comes to advising about what to order.

Possibly the trickiest part of the job – with no easy answer! It feels like the goalposts as regards what is appropriate have always moved, but are now moving rapidly, and as a result radiology practice is quite heterogeneous. In the UK we have some appropriateness criteria published by the Royal College of Radiologists that we can use, but they are vague in many parts. As far as junior non radiologists are concerned, I think education is the key. We radiologists need to grasp this issue and make sure that we are out there delivering education on imaging and how it fits into clinical practice, if we are to have any chance of controlling the tidal wave on requests coming in.

As an EMT, soon to be paramedic, we want to be as effective as we can in preparing patients for extended care as well as immediate. In what way can we help you or others do effective work? What would you say if you could speak to all EMS personnel at once?

Firstly, I’d say thank you for all the important work that you do in pre-hospital care – it is often unrecognised but of vital importance. It is probably not that relevant to radiology but I think my physician colleagues would underline the importance of accurate information from the scene of the medical event and an accurate timeline of what happened to the patient.

To Aspiring Radiologists

Several users asked Dr. Shah for his advice on radiology as a career.

What are the three most important skills an aspiring radiologist has to acquire? I’m finishing my studies soon, so I’m curious!

1. Be open minded and be conscious to developing bias – every now and then you will come across a case where the findings aren’t as expected from the history and examination and you need to make sure you don’t try to force the findings to fit a diagnosis. 2. Be curious and hungry for opportunities to learn knowledge and skills. 3. Have a liking for dark rooms and coffee 😉

Hello, what would you say to someone who is in pre med and wants to be a radiologist?

I’d say: go for it! Take every chance to review the radiology of your patients, spend as much time in the radiology department as possible, work on some projects with radiology residents (audits, posters for meetings). Whichever country you are in, it is important to build up as much experience as possible before applying for residency.

What is the best diet for those that work nights and have a heart condition?

It’s difficult enough to be healthy during night shifts (well at least it was for me when I used to do nights) – unless you’re super organised with meal planning, pretty much the only options are unhealthy fast food. But I think it makes a difference to being able to work effectively – healthy body, healthy mind!

I’m a medical intern on ICU rotation. We come across CXR on a daily basis. What’s the best way to learn how read x rays, matching the medical history with the pics?

You need to understand some of the basic physics behind x-rays (what causes the different densities etc) first. When analysing the pathology, nothing beats going through them with a radiologist or going to as many xray meetings as possible. You’ll find stacks of teaching xrays here and on the internet but being taught 1 on 1 is the best.

The Nitty Gritty

What is the best modality to use for imaging the pancreas? Asking this in light of the difficulty of recognising pancreatic cancers.

Each modality has strengths and weaknesses – and each has a place depending on the specific part of the “journey” the patient is on. Ultrasound is a great mass screening tool. CT has the best spatial resolution but carries a radiation penalty. MRI has the best contrast resolution and allows multiphase imaging (lots of scans after contrast) but suffers from breathing artifact.

I have a small question: how can realise small closed pnemothorax in the PA [posterior-anterior]-Thorax? It is really difficult.

When they are small, they are difficult. Look very closely for the pleural line, use the magnification feature in your image-viewing software, and sometimes inverting the image helps too.